| NPI | 1770630311 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC1900X Psychologist, Counseling (Licence: NJ 4616) |
| Additional Taxonomies | 103TC1900X Psychologist, Counseling (Licence: AL 1486) |
| Enumeration Date | 2007-01-05 |
| Last Update Date | 2010-06-13 |